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CVD, Cardiac Injury, and Death in Critically Ill COVID-19 Patients
Quick Takes
- Cardiovascular risk factors rather than CVD were the main contributors to in-hospital outcomes in patients with severe COVID-19.
- Myocardial injury was strongly associated with death and cardiovascular events regardless of a history of CVD and possibly reflected the severity of the acute illness rather than exacerbation of pre-existing disease.
- Patients with CVD should be considered as high-risk due to their burden of shared risk factors with severe COVID-19 outcomes such as hypertension, diabetes mellitus, obesity, and smoking.
Study Questions:
What is the impact of pre-existing cardiovascular disease (CVD) on in-hospital death and cardiovascular events in critically ill patients with coronavirus disease 2019 (COVID-19)?
Methods:
The investigators used data from a multicenter cohort of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 centers across the United States from March 1–July 1, 2020. The primary exposure was CVD, defined as coronary artery disease (CAD), congestive heart failure (HF), or atrial fibrillation/flutter. Myocardial injury on ICU admission defined as a troponin I or T level above the 99th percentile upper reference limit of normal was a secondary exposure. The primary outcome was 28-day in-hospital mortality. Secondary outcomes included cardiovascular events (cardiac arrest, new-onset arrhythmias, new-onset heart failure, myocarditis, pericarditis, or stroke) within 14 days. The authors used multivariable logistic regression models to investigate the relationship between exposures and outcomes (death and cardiovascular events at 28 and 14 days, respectively).
Results:
Among 5,133 patients (3,231 male [62.9%]; mean age 61 years [standard deviation, 15 years]), 1,174 (22.9%) had pre-existing CVD. A total of 1,178 (34.6%) died, and 920 (17.9%) had a cardiovascular event. After adjusting for age, sex, race, body mass index (BMI), history of smoking, and comorbidities, pre-existing CVD was associated with a 1.15 (95% confidence interval [CI], 0.98-1.34) higher odds of death. No independent association was observed between pre-existing CVD and cardiovascular events. Myocardial injury on ICU admission was associated with higher odds of death (adjusted odds ratio, 1.93 [95% CI, 1.61-2.31]) and cardiovascular events (adjusted odds ratio, 1.82 [95% CI, 1.47-2.24]), regardless of the presence of CVD.
Conclusions:
The authors concluded that CVD risk factors, rather than CVD itself, were the major contributors to outcomes in critically ill patients with COVID-19.
Perspective:
This multicenter cohort study of critically ill adult patients hospitalized for COVID-19 in the United States reports that cardiovascular risk factors rather than CVD (defined by the presence of CAD, HF, or atrial fibrillation) were the main contributors to in-hospital outcomes in patients with severe COVID-19. Of note, age, BMI, smoking, hypertension, and diabetes were the most important contributors to mortality. Furthermore, myocardial injury was strongly associated with death and cardiovascular events regardless of a history of CVD and possibly reflected the severity of the acute illness rather than exacerbation of pre-existing disease. Finally, patients with CVD should be considered as high-risk due to their burden of shared risk factors with severe COVID-19 outcomes such as hypertension, diabetes mellitus, obesity, and smoking.
Clinical Topics: Arrhythmias and Clinical EP, COVID-19 Hub, Heart Failure and Cardiomyopathies, Pericardial Disease, Prevention, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension, Smoking
Keywords: Acute Disease, Arrhythmias, Cardiac, Atrial Fibrillation, Body Mass Index, Coronary Artery Disease, COVID-19, Critical Illness, Diabetes Mellitus, Heart Arrest, Heart Failure, Hospital Mortality, Hypertension, Intensive Care Units, Myocardial Ischemia, Myocarditis, Obesity, Pericarditis, Preexisting Condition Coverage, Primary Prevention, Risk Factors, Smoking, Stroke, Troponin
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